Comparison of Drug-Eluting Stents Versus Surgery for Unprotected Left Main Coronary Artery Disease

Sanmartín, Marcelo; Baz, José Antonio; Claro, Ramón; Asorey, Vanesa; Durán, Darío; Pradas, Gonzalo; Íñiguez, Andrés

doi:10.1016/j.amjcard.2007.04.037

Cited by 112 publications

(73 citation statements)

References 17 publications

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“…[10][11][12] Studies comparing PCI involving drugeluting stents with CABG have generally been smaller and nonrandomized. [13][14][15][16][17][18][19][20][21][22][23][24] Data from randomized, controlled trials of drug-eluting stents as compared with bare-metal stents have shown significant reductions in the rate of repeat intervention, with similar rates of death and myocardial infarction. 25 These improvements have led to expanded use of PCI in patients with complex coronary anatomical features, though most randomized trials comparing drugeluting stents and bare-metal stents excluded such patients.…”

mentioning

confidence: 99%

Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease

Serruys¹,

et al. 2009

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mentioning

confidence: 99%

Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease

Serruys¹,

et al. 2009

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“…A review of the 2011 PCI guideline and Data Supplements 3 and 4 12 revealed that 4 randomized trials [13][14][15][16] and 8 cohort studies [17][18][19][20][21][22][23][24] comprised the evidence for the new Class IIa recommendation for PCI to improve survival in patients with ULMCAD, whereas 7 older studies formed the knowledge base to show that CABG confers a survival advantage over MT in patients with ULMCAD. [2][3][4][5][6][7][8] The 19 studies used predefined enrollment criteria and were published in peer-reviewed journals.…”

Section: Methodsmentioning

confidence: 99%

“…Evidence for the second premise comes from 4 randomized trials [13][14][15][16] and 8 cohort studies, [17][18][19][20][21][22][23][24] all reported during the past 7 years.…”

Section: Clinical Perspective On P 2185mentioning

confidence: 99%

“…We assumed that the number of deaths in the CABG arm arose from a binomial distribution and that the log-odds of the study-specific CABG mortality rate had a noninformative normal prior distribution. For the 12 studies that directly compared CABG with PCI, [13][14][15][16][17][18][19][20][21][22][23][24] we assumed that the number of deaths in the PCI arm was also a binomial variable with the log-odds of the study-specific PCI mortality rate modeled as the rate for the CABG surgery arm plus a study-specific increment associated with the PCI arm. The study-specific effect attributed to PCI was assumed to arise from a normal distribution with unknown mean and unknown PCI-specific between-study variance.…”

Section: Bayesian Meta-analysesmentioning

confidence: 99%

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Bayesian Methods Affirm the Use of Percutaneous Coronary Intervention to Improve Survival in Patients With Unprotected Left Main Coronary Artery Disease

Bittl

Jacobs

et al. 2013

Circulation

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Background-Several randomized clinical trials support the use of coronary artery bypass grafting (CABG) for patients with unprotected left main coronary artery disease. Studies suggesting the equivalence of percutaneous coronary intervention (PCI) with CABG for this indication indirectly support the 2011 American College of Cardiology Foundation/American Heart Association Class IIa recommendation for PCI to improve survival in patients with unprotected left main coronary artery disease. We tested whether bayesian approaches uphold the new recommendation. Methods and Results-We performed a bayesian cross-design and network meta-analysis of 12 studies (4 randomized clinical trials and 8 observational studies) comparing CABG with PCI (n=4574 patients) and of 7 studies (2 randomized clinical trials and 5 observational studies) comparing CABG with medical therapy (n=3224 patients). The odds ratios of 1-year mortality after PCI compared with CABG using bayesian cross-design meta-analysis were not different among randomized clinical trials (odds ratio, 0.99; 95% bayesian credible interval, 0.67-1.43), matched cohort studies (odds ratio, 1.10; 95% bayesian credible interval, 0.76-1.73), and other types of cohort studies (odds ratio, 0.93; 95% bayesian credible interval, 0.58-1.35). A network meta-analysis suggested that medical therapy is associated with higher 1-year mortality than the use of PCI for patients with unprotected left main coronary artery disease (odds ratio, 3.22; 95% bayesian credible interval, 1.96-5.30). Conclusions-Bayesian methods support the current guidelines, which were based on traditional statistical methods and have proposed that PCI, like CABG, improves survival for patients with unprotected left main coronary artery disease compared with medical therapy. An integrated approach using both direct and indirect evidence may yield new insights to enhance the translation of clinical trial data into practice.

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“…[147][148][149] Several studies comparing CABG to PCI, however, indicated that the advantage of CABG consists primarily of fewer repeat revascularizations. 139,[149][150][151][152][153][154][155] The study by Brener et al 156 indicates no significant mortality difference between PCI and CABG after 3 years of follow-up. Longer-term follow-up is needed.…”

Section: Recommendations For Pci For Unprotected Left Main Coronary Amentioning

confidence: 99%

2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST‐Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update)

Kushner¹,

Hand

Smith³

et al. 2009

Cathet Cardio Intervent

113

102

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Comparison of Drug-Eluting Stents Versus Surgery for Unprotected Left Main Coronary Artery Disease

Cited by 112 publications

References 17 publications

Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease

Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease

Bayesian Methods Affirm the Use of Percutaneous Coronary Intervention to Improve Survival in Patients With Unprotected Left Main Coronary Artery Disease

2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST‐Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update)

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